1. Wound Care and Limb Salvage St. Luke’s – Roosevelt Hospital Center

2. Goals Retain limbs Retain limbs  Minimally invasive and invasive therapy Aggressive treatment of wounds Aggressive treatment of wounds  Wound care team algorithms  Clinical trial access  Cutting edge therapeutic interventions  Aggressive rehabilitation services

3. How we achieve these goals? Aggressive attempts at limb salvage Aggressive attempts at limb salvage  Using a combination of techniques When a wound is inevitable When a wound is inevitable  Inpatient wound care team  Outpatient wound care team  Standardized formulary  Individualized plan for each patient

4. Invasive surgical options

5. Minimally invasive techniques

6. Outcomes of Aggressive intervention 5 year 1° patency – 65 to 70 % 5 year 1° patency – 65 to 70 % 5 year 2° patency – 80 to 85 % 5 year 2° patency – 80 to 85 % 5 year limb salvage – 85 to 90% 5 year limb salvage – 85 to 90%

7. Wound care team Speeds time to recovery Speeds time to recovery  Integrates different experience  Integrates different perspectives  Provides increased continuity  Decreases contradictory treatment application

8. Wound care team Allows for better development and application of algorithms Allows for better development and application of algorithms  Aids in patient and caregiver education  Provides for equal voice from various care backgrounds  Much easier to implement preventive strategies

9. Application of the Team Concept/ Standardized Formulary Further sub-specialization Further sub-specialization  Diabetic foot team  Amputation team  Decubitus team Stoma teamStoma team

10. Standardized Formulary Allows for less caregiver and patient confusion Allows for less caregiver and patient confusion Decreases cost Decreases cost Decreases lapses in therapy once initiated Decreases lapses in therapy once initiated Improves time to recovery ? Improves time to recovery ?

11. Specific team requirements Diabetic foot Diabetic foot  Diabetologist- Inpatient and Outpatient  Nurse specialist - VNS liason  Nutritionist  Physical therapist - Outpatient liason  Podiatrist  Prosthetist  Social worker  Vascular surgeon (Team leader)

12. Specific team requirements Amputation Team Amputation Team  Nurse specialist - VNS liason  Nutritionist  Physical therapist - Outpatient liason  Podiatrist  Prosthetist  Vascular / Orthopedic surgeon  Social worker  Psychologist

13. Novel approaches and clinical trials Growth factor studies Growth factor studies Vacuum Assisted Closure Device studies Vacuum Assisted Closure Device studies Drug eluting stent trials Drug eluting stent trials  At present seven active clinical trials focused at these problems Multidisciplinary plan of care Multidisciplinary plan of care